Online Access to BannerWeb - PNTR

Web Inquiry Form

Please enter your full name. If you go by a more familiar name, please enter that in the nickname box. To ensure timely delivery of materials, please use proper capitalization and punctuation.

Name

Prefix:

First Name:

Middle Name:

Last Name:

Suffix:

Nickname:

Please enter your home mailing address and e-mail correctly. All communications will be sent through e-mail

Home Mailing Address

Valid From:

Month
Day
Year
(YYYY)

Until:

Month
Day
Year
(YYYY)

Address Line 1:

Address Line 2:

Address Line 3:

City:

State or Province:

ZIP or Postal Code:

County:

Nation:

Phone Number:

- (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)

International Access Code:

If you have a different mailing address during the school year, please enter that address here and indicate the approximate valid dates. To ensure timely delivery of materials, please use proper capitalization and punctuation.

School-year Mailing Address

Valid From:

Month
Day
Year
(YYYY)

Until:

Month
Day
Year
(YYYY)

Address Line 1:

Address Line 2:

Address Line 3:

City:

State or Province:

ZIP or Postal Code:

County:

Nation:

Phone Number:

- (xxxxxx)-(xxxxxxxxxxxx) (xxxxxxxxxx extension)

International Access Code:

E-mail Address

E-mail Address:

Verify E-mail Address:

Birthdate

Date of Birth:

Month
Day
Year
(YYYY)

Look-up your college by using the button on the right. Doing so will automatically fill-in College Code, Name, and Address. Please enter additional information as requested.

Undergraduate College/Univ

College Code:

Prior College Name:

Address Line 1:

Address Line 2:

Address Line 3:

City:

State or Province:

ZIP or Postal Code:

Nation:

Attended From:

Attended To:

Graduation Date:

Month
Day
Year
(YYYY)

GPA:

(example: 9.99)

Degree:

Please indicate any programs in which you have a particular interest.

Program of Interest

Interests:

For which term are you interested in receiving application materials?

Expected Term of Entry

Term of Entry:

Please tell us how you first learned about this program.

Learned About Program From:

How I Learned About Online Access to BannerWeb - PNTR:Online Access to BannerWeb - PNTR